超声引导下微创置管治疗创伤性胸腔积液的临床疗效  

Clinical effect of ultrasound-guided minimally invasive catheterization in the treatment of traumatic pleural effusion

作　　者：彭铮磊 田夏元 文碧荣 郑志 李洪波 吕希灵 李猛 Peng Zhenglei;Tian Xiayuan;Wen Birong;Zheng Zhi;Li Hongbo;Lv Xiling;Li Meng(Department of Traumatic Surgery,Zhuzhou Hospital of Traditional Chinese Medicine,Zhuzhou,Hunan 412000,China)

机构地区：[1]株洲市中医伤科医院创伤外科,湖南株洲412000

出　　处：《创伤外科杂志》2021年第9期655-658,共4页Journal of Traumatic Surgery

摘　　要：目的分析经超声引导下应用中心静脉导管微创置管治疗胸部创伤后迟发性胸腔积液的疗效。方法回顾性分析2018年4月—2021年5月株洲市中医伤科医院创伤外科收治的122例单侧或双侧胸部创伤后1~14d经胸部CT检查发现中等量以上的迟发性胸腔积液且伤后无胸腔手术史的患者,男性65例,女性57例;年龄17~78岁,平均51.9岁;道路交通伤57例,高处坠落伤23例,砸伤42例。经床旁超声引导应用中心静脉导管微创置管治疗。治疗后复查胸部CT采用游离胸腔积液体积估算公式计算胸腔积液量评定疗效。结果首日抽液引流量370~760mL,后期每日抽液引流量0~280mL,留管时间0~13d;经治疗87例有效,30例显效,总有效率为95.90%。有4例堵管,经相关处理无法再通予拔管,改常规置粗管引流治愈,彻底堵管发生率为3.27%。3例颅脑损伤伴意识障碍患者治疗后留置导管意外脱落,其中2例治疗后复查胸部CT胸腔积液减少>80%,有效,1例复查胸部CT积液减少<50%,无效,改传统胸腔闭式引流术后治愈,导管脱落发生率为2.45%。1例穿刺点周围疼痛后自行缓解,1例置管抽液600mL留管感胸部疼痛不适而拔管,复查胸部CT示治疗有效,1例穿刺时不适考虑胸膜反应,反应较轻,经暂停操作、安抚患者情绪、吸氧、输液好转,后仍行此法穿刺置管成功,复查胸部CT示治疗有效。穿刺点疼痛、胸膜反应及置管后留管胸部疼痛等并发症发生率为2.45%,未发生胸腔积液增多、气胸、感染、穿刺点周围血肿等医源性损伤。结论经超声引导下应用中心静脉导管微创置管抽液治疗胸部创伤后迟发性胸腔积液方法安全、有效,并发症少,堵管发生率低,患者对置管后留管耐受性好,合并颅脑损伤意识障碍患者使用时有导管意外脱落风险,需加强管道护理。Objective To analyze the effect of ultrasound-guided minimally invasive catheterization of central venous catheter in the treatment of delayed pleural effusion after chest trauma.Methods From Apr.2018 to May 2021,122 patients were included in this retrospective study.All patients underwent no thoracic surgery and developed moderate delayed pleural effusion discovered by CT scan one to 14 days after trauma.There were 65 males and 57 females,aged from 17 to 78 years,with an average age of 51.9.Fifty-seven patients suffered from traffic accident,23 patients suffered from falling injury and 42 suffered from crash injury.Minimally invasive catheterization of central venous catheter was guided by bedside ultrasound.After treatment,chest CT was reviewed to calculate the volume of pleural effusion by the volume estimation formula of free pleural effusion.Results The drainage volume was 370-760mL on the first day,0-280mL every day afterwards.The catheters were kept for 0-13 days.Eight-seven cases showed positive treatment effect,30 of whom showed remarkable curative effect,with a total effective rate of 95.90%.In four cases,the catheters were blocked and therefore changed into regular chest tubes.The incidence of total blockage was 3.27%.In three patients with craniocerebral injury and disturbance of consciousness,the catheters fell off,two of whom showed a reduction of at least 80%pleural effusion on CT scan,one of whom showed a reduction of less than 50%pleural effusion on CT scan and therefore changed into traditional chest tube with positive curative effect.The incidence of catheter displacement was 2.45%.One patient had pain around the insertion area and was relieved afterwards.One patient felt chest pain after removing 600mL of pleural effusion and then removed the catheter,in whom CT scan showed positive curative effect.One patient had mild pleural reaction and the catheterization was done after comforting the patients and use of oxygen and transfusion,with positive effect on CT scan.The incidence of complications

关 键 词：胸部创伤 胸腔积液 中心静脉导管 微创置管 

分 类 号：R608[医药卫生—外科学]